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Open AccessArticle

Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression

1
Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL 60611, USA
2
Department of Communication Studies, Northwestern University, Chicago, IL 60611, USA
3
Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA
4
Biostatistics Collaboration Center, Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(23), 4689; https://doi.org/10.3390/ijerph16234689
Received: 3 October 2019 / Revised: 21 November 2019 / Accepted: 22 November 2019 / Published: 25 November 2019
(This article belongs to the Special Issue The Interface between the Internet and Mental Health)
Internet-based cognitive behavioral therapy (iCBT) may overcome barriers to mental health care and has proven efficacious. However, this approach currently exists outside the existing mental health care delivery system. Stepped care is a proposed framework for integrating digital mental health (DMH) into health systems by initiating iCBT and “stepping up” care to a more intensive intervention should iCBT prove ineffective. This study explores pre-treatment factors associated with reaching stepping criteria among patients receiving iCBT. This exploratory analysis of a stepped care arm of a larger randomized trial examined participants who were stepped to a more intensive intervention if they did not respond to iCBT. The association of pre-treatment factors on stepping were examined using Kruskal–Wallis and Chi-square tests. One-fifth of the 151 participants met criteria for stepping within the 20-week treatment period. Only pre-treatment depression severity and treatment preference were associated with increased likelihood of stepping (p = 0.049 and 0.048, respectively). The low number of individuals who stepped provides support for iCBT as an effective, low intensity treatment for depression. The modest association of pre-treatment depression and preference to not receive iCBT may be useful in identifying patients who are less likely to respond. View Full-Text
Keywords: stepped-care; depression; digital mental health; eHealth; telepsychiatry stepped-care; depression; digital mental health; eHealth; telepsychiatry
MDPI and ACS Style

Nicholas, J.; Ringland, K.E.; Graham, A.K.; Knapp, A.A.; Lattie, E.G.; Kwasny, M.J.; Mohr, D.C. Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression. Int. J. Environ. Res. Public Health 2019, 16, 4689. https://doi.org/10.3390/ijerph16234689

AMA Style

Nicholas J, Ringland KE, Graham AK, Knapp AA, Lattie EG, Kwasny MJ, Mohr DC. Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression. International Journal of Environmental Research and Public Health. 2019; 16(23):4689. https://doi.org/10.3390/ijerph16234689

Chicago/Turabian Style

Nicholas, Jennifer; Ringland, Kathryn E.; Graham, Andrea K.; Knapp, Ashley A.; Lattie, Emily G.; Kwasny, Mary J.; Mohr, David C. 2019. "Stepping Up: Predictors of ‘Stepping’ within an iCBT Stepped-Care Intervention for Depression" Int. J. Environ. Res. Public Health 16, no. 23: 4689. https://doi.org/10.3390/ijerph16234689

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Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

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